Management of toxic exposure in children

Bryant, Sean M.; Singer, Jonathan

doi:10.1016/s0733-8627(02)00083-4

Cited by 30 publications

(17 citation statements)

References 39 publications

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“…The suspected amount consumed is also important because there is often a direct relationship with the volume consumed and the likelihood of an adverse clinical manifestation. 3 The 23 products or pharmaceuticals capable of killing young patients with even a small ingestion (1-2 teaspoons or 1-2 tablets) are listed in Table 2. 25 Other important pieces of information include time since ingestion, route of ingestion, expiration date, and any therapeutic interventions attempted.…”

Section: Discussionmentioning

confidence: 99%

Atypical Altered Mental Status in a Toddler

Dickinson

Smith

Raees

et al. 2017

Hospital Pediatrics

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A 2-year-old girl presented with 2 days of altered mental status (AMS). Symptoms included increased sleepiness, irritability, aggression, decreased oral intake and urine output, as well as weakness and refusal to walk. Her history was negative for fever, cough, rhinorrhea, vomiting, diarrhea, rashes, seizurelike activity, recent head trauma, or other injuries. There were no known sick contacts or recent travels. She did attend day care. The family reported no medications in the home.In triage, she was afebrile with a pulse of 125 beats per minute, respiratory rate of 21 breaths per minute, blood pressure of 103/79, and oxygen saturation of 100% on room air. On examination, the child was sleepy and difficult to arouse. Her neurologic examination was notable for irritability, delayed response to stimuli, ataxia, and a Glasgow Coma Scale of 14. There were no focal neurologic defects appreciated.Question: What are the current recommendations for the evaluation of a child with AMS? DiscussionAMS is defined as a change in a patient' s awareness of self or how a patient interacts with their environment. 1,2 AMS is a complex presenting symptom with a wide range of severity and broad differential that varies by a patient' s age ( Table 1).The basics of emergency management (including airway, breathing, and circulation) should guide any initial evaluation. A clinician must then attempt to distinguish between causes for AMS by using a systematic approach for evaluation and diagnostic testing. The mnemonic VITAMIN C (vascular, infectious, trauma, autoimmune/allergy, metabolic/mass lesion, idiopathic/iatrogenic, neoplasm, and congenital) can be used as a quick reminder of the potential causes of AMS.A thorough history from family members and other sources including neighbors, prehospital personnel, or law enforcement is imperative. 3,4 A complete review of systems, as well as the patient' s past medical history (including previous ingestions, recent medication changes, or propensity for infection or metabolic derangements), are also important in guiding management. Vital signs, particularly fever, can help point to an infectious cause; however, ingestions can also lead to significant vital sign abnormalities. Alterations in respiratory patterns may suggest toxic or metabolic derangements, whereas bradycardia and hypertension may point to increased intracranial pressure. The physical examination must include a complete neurologic examination focusing on

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Section: Discussionmentioning

confidence: 99%

Atypical Altered Mental Status in a Toddler

Dickinson

Smith

Raees

et al. 2017

Hospital Pediatrics

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“…Suicidal attempts using organophosphates are more common in communities involved in agriculture. The major clinical manifestations in children are neurological, rather than nicotinic or muscarinic symptoms in contrast to adults [1]. Organophosphates inhibit acetylcholinesterase (AChE) activity by phosphorylating the serine hydroxyl group located at the active site of AChE.…”

Section: Discussionmentioning

confidence: 99%

Plasmapheresis in Organophosphorus Poisoning – Intensive Management and its Successful Use

Dnb¹

2012

J Clinic Toxicol

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Management of Organophosphorus poisoning can be difficult at times, especially when there is no history of poisoning or where the compound is not known to begin with & which is compounded by the absence of odour. Plasmapheresis has been tried effectively in toxicology in the treatment of various toxic substances ingestion, and can replace circulating cholinesterase in these patients with organophosphate poisoning. We report a case of young boy who initially presented with unknown compound poisoning, but subsequently had clinical features of organophosphorus poisoning alongwith reduced levels of acetyl cholinesterase, managed by plasmapheresis.

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“…1,3,4 En lo que respecta a la nicotina, aún se menciona poco dentro del grupo de "exposiciones potencialmente letales en pediatría"; sin embargo, debido a la reciente inclusión de presentaciones líquidas, los accidentes asociados con este agente son cada vez más frecuentes y confieren un riesgo real de letalidad a bajas dosis, 54,56 por lo que se determinó su inclusión en el presente trabajo.…”

Section: Conclusionesunclassified

“…2 Lo anterior guarda una relación estrecha con factores de riesgo que dependen del paciente, pero también de su entorno y de la propia sustancia, los cuales en su conjunto determinan si se presenta o no una intoxicación. 3,4 Dentro de los factores predisponentes más importantes del paciente encontramos: su completo desconocimiento del potencial efecto dañino que poseen las sustancias que le rodean y su avidez por la experimentación a través del gusto, además de que su peso y superficie corporal reducidos contribuyen a alcanzar las dosis tóxi-cas con relativa facilidad. Por otra parte, entre las condiciones ambientales involucradas con estos accidentes podemos observar: la presencia de sustancias tóxicas al alcance de los niños, envases que no cuentan con tapas de seguridad, líquidos tóxicos contenidos en botellas de bebidas o que se presentan en colores vivos, de aspecto o aroma atrayente, así como gavetas o cajones con medicamentos que los familiares conservan en casa.…”

Section: Introductionunclassified

CHAMACON: exposiciones potencialmente letales en pediatría

Bazán-Godínez

Pérez-Tuñon

2016

Acta Pediatr Mex

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Accidental exposure to potentially toxic substances is a common problem in children. This condition could be catastrophic, depending on factors associated with the patient, their environment and the substance involved. In this sense, there is a group of commonly used substances that when ingested by an infant, even in small amounts (one tablet, sip or spoonful), may cause death, either because they are highly toxic or simply because they are in a high concentration. When a child ingests any of these substances, it should be recognized as "a potentially lethal exposure". We propose the mnemonics CHAMA-CON to identify those substances and subsequently, we mentioned key aspects for the initial treatment in this exposures. KEYWORDS: poisoning in children; lethal exposures in pediatricsActa Pediatr Mex. 2016 jul;37(4):228-240. CHAMACON: exposiciones potencialmente letales en pediatría ResumenLa exposición accidental a sustancias potencialmente tóxicas es un problema frecuente en pediatría. Esta condición puede ser catastrófica dependiendo de factores propios del paciente, su entorno y de la propia sustancia a la que fue expuesto. En este sentido, existe un grupo de sustancias de uso común que al ser ingeridas por un lactante, aun en cantidades mínimas (una tableta, un sorbo o una cucharada), pueden causarle la muerte, ya sea porque son altamente tóxicas o simplemente porque se encuentran en una gran concentración. Cuando un niño ingiere cualquier sustancia de este grupo debe reconocerse como una "exposición potencialmente letal en pediatría". En el presente trabajo se propone la nemotecnia CHAMACON para lograr un sencillo reconocimiento de dichas sustancias y posteriormente se abordan aspectos clave en el abordaje inicial del paciente que ha presentado una exposición de esta índole.PALABRAS CLAVE: intoxicaciones en niños, exposiciones letales en pediatría.

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Management of toxic exposure in children

Cited by 30 publications

References 39 publications

Atypical Altered Mental Status in a Toddler

Atypical Altered Mental Status in a Toddler

Plasmapheresis in Organophosphorus Poisoning – Intensive Management and its Successful Use

CHAMACON: exposiciones potencialmente letales en pediatría

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